Nose Breathing Children Research Articles

Alterations in Oral-Nasal-Pharyngeal Microbiota and Salivary Proteins in Mouth-Breathing Children.

Mouth breathing induces a series of diseases, while the influence on microbiota of oral cavity and salivary proteins remains unknown. In this study, for the first time, profiles of oral–nasal–pharyngeal microbiota among mouth-breathing children (MB group, n = 10) were compared with paired nose-breathing children (NB group, n = 10) using 16S ribosomal DNA (rDNA) (V3–V4 region) high-throughput sequencing. The differentially expressed salivary proteins were revealed using label-free quantification (LFQ) method, and their associations with bacterial abundance were measured by canonical correspondence analysis (CCA). The overall bacterial profiles differed between the two groups, and the differences were related to the duration of mouth breathing. The diversity of oral–pharyngeal microbiota was significantly higher, and the nasal–pharyngeal species tended to be consistent (unweighted UniFrac, p = 0.38) in the MB group. Opportunistic pathogens were higher in relative abundance as follows: Acinetobacter in the anterior supragingival plaque, Neisseria in unstimulated saliva, Streptococcus pneumoniae in the pharynx, and Stenotrophomonas in the nostrils. The expression level of oxidative-stress-related salivary proteins (lactoylglutathione lyase and peroxiredoxin-5) were upregulated, while immune-related proteins (integrin alpha-M and proteasome subunit alpha type-1) were downregulated in MB group. The differentially expressed proteins were associated with specific bacteria, indicating their potentials as candidate biomarkers for the diagnosis, putatively early intervention, and therapeutic target of mouth breathing. This study showed that mouth breathing influences the oral–nasal–pharyngeal microbiota and enriches certain pathogens, accompanied with the alterations in the salivary environment. Further research on the pathological mechanisms and dynamic changes in longitudinal studies are warranted.

Three-dimensional morphological analysis of the palate of mouth-breathing children in mixed dentition

To study the effects of mouth-breathing on maxillary arch development by comparing the palatal morphology of mouth- and nose-breathing children in mixed dentition. Children in mixed dentition were enrolled and categorized into mouth-breathing (test group) and nose-breathing groups (control group) according to their breathing patterns. Children's plaster models were scanned with 3D laser scanner, and the 3D data were reconstructed and measured using Minics 15.0 and Geomagic 12.0 software. Measurement data (inter-molar width, palatal height, palatal volume, and palatal surface area) of the two groups were compared, and the correlation among the four measurement items was analyzed. The participants were 73 children (37 in test group and 36 in control group) with a mean age of (8.63±0.78) years old. The test group had significantly smaller inter-molar width, palatal volume, and palatal surface area but significantly higher palatal height than the control group (P<0.05). Inter-molar width and palatal volume were positively correlated with the palatal surface area in the test group (P<0.05). Inter-molar width and palatal height were positively correlated with the palatal surface area in the control group (P<0.01). Mouth-breathing children have significantly reduced inter-molar width, palatal volume, and surface, and substantially increased palatal height, leading to different developmental patterns of the palatal morphology.

Body posture and pulmonary function in mouth and nose breathing children: cross-sectional study

Abstract Introduction: Mouth breathing can lead to changes in body posture and pulmonary function. However, the consequences are still inconclusive and a number of studies are controversial. Objective: Evaluate and correlate spirometric parameters and postural measures in mouth breathing children, and compare them to nose breathers. Methods: two groups of 6 to 12 year-old children were evaluated: mouth breathers (MB, n = 55) and nose breathers (NB, n = 45). Spirometry and body posture analysis using photogrammetry (SAPo 0.68® v) were carried out. The following spirometric measures were evaluated: peak expiratory flow (PEF), forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), FEV1/FVC ratio (%) and forced expiratory flow between 25% and 75% of FVC (FEF 25-75%). Biophotogrammetric measures analyzed were: horizontal alignment of acromions (HAA) and anterior superior iliac spine (HAASIS), Charpy angle, horizontal alignment of the head (HAH), cervical lordosis (CL), thoracic kyphosis (TK), lumbar lordosis (LL), cervical distance (CD) and lumbar distance (LD). Results: There were no intergroup differences in spirometric and postural variables. Positive and moderate correlations were found between CL and CD measures with PEF, FEV1, FVC and FEF 25-75%, while weak correlations were observed between lumbar lordosis and PEF, FEV1 and FVC. Conclusion: The breathing mode had no influence on postural and respiratory measures. However, greater forward head posture, with smaller cervical lordosis, was related to higher lung volumes and flows in both groups.

Comparison of cephalometric patterns in mouth breathing and nose breathing children

ObjectiveThe aim of this study was to compare cephalometric values between nasal and oral breathing children and to measure the upper and lower airway space in both groups. MethodsThe study was conducted on 118 pediatric patients, 51 girls and 67 boys, from the Dental Clinic of the Universidad Europea de Madrid. The age ranges of the sample were 6–12 years old. 53 of them were mouth breathers and 65 nose breathers. Lateral cephalometric radiographs were obtained for all of the subjects. The radiographs were analyzed and a cephalometric tracing was performed on each one. ResultsThe mouth breathing children showed a more retruded mandible (SNB), and a greater inclination of the mandibular plane (NS-Go Gn) and occlusal plane (NS-O Pl.), than the nose breathing children (P<0.05). The mouth breathing group also had a higher frequency of having the hyoid bone in a more elevated position and the nasopharyngeal air space significantly smaller than the nasal breathing group (P<0.001). ConclusionMouth breathing children seem to have an increase in anterior lower facial height, the hyoid bone in a more elevated position and higher tendency towards having a class II malocclusion compared to nose breathing children.

Polysomnographic Findings are Associated with Cephalometric Measurements in Mouth-Breathing Children

Children with adenotonsillar hypertrophy and those with an abnormal craniofacial morphology are predisposed to having sleep disordered breathing; many of these children are mouth breathers. The aim of this study was to determine whether an association exists between polysomnographic findings and cephalometric measures in mouth-breathing children. Twenty-seven children (15 mouth-breathing children and 12 nose-breathing children [control subjects]), aged 7 to 14 years, took part in the study. Polysomnographic variables included sleep efficiency, sleep latency, apnea-hypopnea index, oxygen saturation, arousal index, number of periodic limb movements in sleep, and snoring. Cephalometric measures included maxilla and mandible position, occlusal and mandibular plane inclination, incisor position, pharyngeal airway space width, and hyoid bone position. As compared with nose-breathing children, mouth breathers were more likely to snore (p < 0.001) and to have an apnea-hypopnea index greater than 1 (p = 0.02). Mouth-breathing children were also more likely to have a retruded mandible, more inclined occlusal and mandibular planes, a smaller airway space, and a smaller superior pharyngeal airway space (p < 0.01). The apnea-hypopnea index increased as the posterior airway space decreased (p = 0.05). Our study showed an association between polysomnographic data and cephalometric measures in mouth-breathing children. Snoring was the most important variable associated with abnormal craniofacial morphology. Orthodontists should send any mouth-breathing child for an evaluation of sleep if they find that the child has a small superior pharyngeal airway space or an increased ANB (the relationship between the maxilla and mandible), NS.PIO (occlusal plane inclination in relationship to the skull base), or NS.GoGn (the mandibular plane inclination in relation to the skull base), indicating that the child has a steeper mandibular plane.

Mouth breathing children have cephalometric patterns similar to those of adult patients with obstructive sleep apnea syndrome

To determine whether mouth breathing children present the same cephalometric patterns as patients with obstructive sleep apnea syndrome (OSAS). Cephalometric variables were traced and measured on vertical lateral cephalometric radiographs. The cephalometric measurements of 52 mouth and 90 nose breathing children were compared with apneic patients. The children had not undergone adenoidectomy or tonsillectomy and had not had or were not receiving orthodontic or orthopedic treatment. Mouth breathing children showed same cephalometric pattern observed in patients with OSAS: a tendency to have a retruded mandible (p=0.05), along with greater inclination of the mandibular and occlusal planes (p<0.01) and a tendency to have greater inclination of the upper incisors (p=0.08). The nasopharyngeal and posterior airway spaces were greatly reduced in mouth breathing children, as observed in patients with apnea (p<0.01). Mouth breathing children present abnormal cephalometric parameters and their craniofacial morphology resembles that of patients with OSAS.

Padrão respiratório e movimento toracoabdominal de crianças respiradoras orais

OBJECTIVE: To characterize the breathing pattern and thoracoabdominal motion of mouth-breathing children aged between eight and ten years and to compare these characteristics with those of nose-breathing children of the same ages. METHODS: This observational study was carried out in a university laboratory. The sample size of 50 subjects was estimated based on the results of a pilot study with ten children in each group (total of 20 children) and considering a significance level of 0.05 and statistical power of 0.80. Twenty-six mouth-breathing and 25 nose-breathing children participated. Calibrated respiratory inductive plethysmography was used to analyze the following variables, among others: respiratory frequency (f), rib cage contribution towards tidal volume (%RC/Vt), phase angle (PhAng) and the ratio between time taken to reach peak inspiratory flow and total inspiratory time (PifT/Ti). Peripheral oxygen saturation of hemoglobin (SpO2) was measured using pulse oximetry. Statistical analysis was performed using the Student's t test for independent groups or the Mann-Whitney U test, according to the sample distribution of the variables. RESULTS: A total of 4,816 respiratory cycles were analyzed: 2,455 from mouth-breathers and 2,361 from nose-breathers, with a mean of 94 cycles per child. No statistically significant differences were observed between the groups, for the variables studied (f=20.00±2.68 versus 20.73±2.58, p=0.169; %RC/Vt=39.30±11.86 versus 38.36±10.93, p=0.769; PhAng=14.53±7.97 versus 13.31±7.74, p=0.583; PifT/Ti=57.40±7.16 versus 58.35±5.99, p=0.610; SpO2=96.42±1.52% versus 96.88± 1.01%, p=0.208; respectively). CONCLUSIONS: These results suggest that mouth-breathing children show breathing patterns and thoracoabdominal motion that are similar to those of nose-breathing children in the same age group.

Relação entre a excursão do músculo diafragma e as curvaturas da coluna vertebral em crianças respiradoras bucais

OBJECTIVE: To investigate the relationship between excursion of the diaphragm muscle and spinal curvatures in mouth breathing children. METHODS: A total of 52 children of both sexes, aged from 5 to 12 years, were studied. After otorhinolaryngological assessment, the children were divided into two groups: mouth breathers and nose breathers. All of the children underwent videofluoroscopic examination of the diaphragm muscle and postural assessment. Diaphragm excursion was analyzed using Adobe Photoshop® software, and postural assessment was recorded using photographs in left lateral view, which were then analyzed using SAPO postural assessment software. RESULTS: The groups studied exhibited statistically significant differences in terms of spinal curvatures (cervical lordosis: p = 0.003; lumbar lordosis: p = 0.001; thoracic kyphosis: p = 0.002; position of the pelvis: p = 0.001) and diaphragm excursion (right side diaphragm: p = 0.001; left side diaphragm: p = 0.001). The mouth breathing group exhibited reduced cervical lordosis, increased thoracic kyphosis, increased lumbar lordosis and the position of the pelvis was tilted forward. The distance traveled outwards by the diaphragm muscles of mouth breathing children was shorter than that traveled by the muscles of nose breathing children. The relationship between the behavior of spinal curvatures and diaphragm excursion had no statistical significance. CONCLUSION: There was no relationship between spinal curvatures and diaphragm excursion in the groups studied here.

The relationship between excursion of the diaphragm and curvatures of the spinal column in mouth breathing children

To investigate the relationship between excursion of the diaphragm muscle and spinal curvatures in mouth breathing children. A total of 52 children of both sexes, aged from 5 to 12 years, were studied. After otorhinolaryngological assessment, the children were divided into two groups: mouth breathers and nose breathers. All of the children underwent videofluoroscopic examination of the diaphragm muscle and postural assessment. Diaphragm excursion was analyzed using Adobe Photoshop software, and postural assessment was recorded using photographs in left lateral view, which were then analyzed using SAPO postural assessment software. The groups studied exhibited statistically significant differences in terms of spinal curvatures (cervical lordosis: p = 0.003; lumbar lordosis: p = 0.001; thoracic kyphosis: p = 0.002; position of the pelvis: p = 0.001) and diaphragm excursion (right side diaphragm: p = 0.001; left side diaphragm: p = 0.001). The mouth breathing group exhibited reduced cervical lordosis, increased thoracic kyphosis, increased lumbar lordosis and the position of the pelvis was tilted forward. The distance traveled outwards by the diaphragm muscles of mouth breathing children was shorter than that traveled by the muscles of nose breathing children. The relationship between the behavior of spinal curvatures and diaphragm excursion had no statistical significance. There was no relationship between spinal curvatures and diaphragm excursion in the groups studied here.

Mensuração da amplitude de movimento cervical em crianças respiradoras orais

Measurement of neck range of motion among mouth-breathing children Introduction: By clinical definition, mouth breathers use the mouth as their main air pathway during breathing. This results in modifications to tongue and head positioning and may have an influence on craniofacial mechanics during development. Bringing the head forward is also common among mouth breathers and may lead to misalignments in adjacent segments of the human body. Objective: To evaluate neck (cervical) range of motion (ROM) among mouth-breathing children and compare this with a group of nose-breathing children. Method: Ten mouth-breathing children of both sexes aged 6.90 ± 1.37 years and ten nose- breathing children aged 7.70 ± 1.42 years participated in this study. The ROM for neck flexion, extension and protrusion of the head were evaluated. Student's t test for independent samples was used for the statistical analysis, considering p< 0.05 as the statistical significance level. Results: The mouth-breathing children had a significantly smaller ROM for neck extension (59.0° ± 10.79°), compared with the nose-breathing group (72.9° ± 8.82° ) (p= 0.001). The ROM for flexion and protrusion was not statistically different between groups (59.0° ± 10.79°). Conclusion: The mouth-breathing children presented smaller neck extension ROM than the nose-breathing children did, but for protrusion and flexion ROM there was no difference between the groups.

ÇOCUKLARDA AĞIZDAN SOLUNUMUN AĞIZ DİŞ SAĞLIĞINA VE ÇEVRE DOKULARA ETKİLERİNİN DEĞERLENDİRİLMESİ EVALUATION OF THE EFFECTS OF MOUTH BREATHING ON ORODENTAL HEALTH AND SURROUNDING TISSUES IN CHILDREN

OZET Bu calisma, cocuklarda agizdan solunumun agiz dis sagligina ve cevre dokulara etkilerinin degerlendirilmesi amaci ile gerceklestirildi. Agizdan ve burundan solunum yapan 5-12 yaslari arasinda toplam 100 cocuk, df, df-s, DMF, DMF-S, kanama, plak indeksleri, marginal gingivitis, yuz sekli, burun, dudak, dil ve cene duruslari yani sira genel durum, uyku bozukluklari, aliskanliklar, davranis bozukluklari acisindan incelendi. Agizdan veya normal solunum yapan cocuklarda df, df-s, DMF, DMF-S degerleri arasinda anlamli farkliliklar (p>0.05) saptanmadi. Agizdan solunum yapan cocuklarin on grup sut dislerinde curuk gorulme sikliginin anlamli olarak daha fazla (p 0.05) were determined between df, df-s, DMF, DMF-S values in mouth and nose breathing children. Significantly (p<0.05) higher caries prevalence in anterior primary teeth was found in mouth breathing children; bleeding and plaque index values were determined higher (p<0.01) in nose breathers than mouth breathers. Significant differences were determined for facial form (p<0.001), nose form (p<0.01), lip posture (p<0.001), chin position (p<0.001), gummy smile (p<0.001) between children with mouth and nose breathing. In addition, in mouth breathing children snoring, sleep apnea syndrome, open mouth posture frequencies were found higher than control groups; however no significancy in behavioural disorders was observed between two groups. Data have demonstrated that mouth breathing could cause significant differences in children's face, nose, lip and chin morphologies; furthermore, it has been determined that other parameters regarding oral hygiene besides mouth breathing have also important roles on health of teeth and gingiva. Key Words: mouth breathing, health of tooth and gingiva

Breathing mode influence in craniofacial development

SummaryAimthe aim of this study was to evaluate the differences in facial proportions of nose and mouth breathing children using cephalometric analysis.Study designtransversal cohort.Material and MethodSixty cephalometric radiographs from pediatric patients aged 6 to 10 years were used. After otorhinolaryngological evaluation, patients were divided into two groups: Group I, with mouth breathing children and group II, with nose breathers. Standard lateral cephalometric radiographs were obtained to evaluate facial proportions using the following measures: SN.GoGn, ArGo.GoMe, N-Me, N-ANS, ANS-Me and S-Go; and the following indexes: PFH-AFH ratio: S-Go/N-Me; LFH-AFH ratio: ANS-Me/N-Me and UFH-LFH ratio: N-ANS/ANS-Me.ResultsIt was observed that the measurements for the inclination of the mandibular plane (SN.GoGn) in mouth breathing children were statistically higher than those in nasal breathing children. The posterior facial height was statistically smaller than the anterior one in mouth breathing children (PFH-AFH ratio). Thus, the upper anterior facial height was statistically smaller than the lower facial height (UFH-LFH ratio).ConclusionWe concluded that mouth breathing children tend to have higher mandibular inclination and more vertical growth. These findings support the influence of the breathing mode in craniofacial development.

Dentofacial morphology of mouth breathing children.

The relationship between dentofacial morphology and respiration has been debated and investigated from various approaches. The aim of this study was to verify the skeletal and dental relationship of mouth and nose breathing children. Thirty-five children, 7 to 10 years of age, were submitted to orthodontic and otorhinolaryngologic evaluations and were separated into 2 groups: 15 nose breathers and 20 mouth breathers. Each subject underwent a cephalometric radiograph analysis. Statistical analysis (Mann-Whitney U test) indicated that changed mode of breathing was associated with 1) maxillo-mandibular retrusion in relation to the cranial base in the mouth breathers; 2) the SNGoGn and NSGn angles were greater in the mouth breathing group; 3) incisor inclination in both jaws and the interincisal angle were not different between groups. There was no statistically significant difference in the maxillary and mandibular molar heights between the nose breathers and mouth breathers.

Acoustic rhinometry in pre-school children

Acoustic rhinometry was performed in 35 normal nose-breathing children between 3 and 6 years. The average cross-sectional areas at the nasal valve, at the anterior end of the turbinates, and in the nasopharynx were 0.34 +/- 0.06 cm2, 0.35 +/- 0.08 cm2 and 1.37 +/- 0.48 cm2 respectively. The average minimal cross-sectional area was 0.29 +/- 0.06 cm2. The minimal cross-sectional area was located at the nasal valve in 14 and at the anterior end of nasal turbinates in 21 of the 35 children. As would be expected, the cross-sectional areas at different sites of the nasal cavity increased with increasing age of the children. But, whereas the minimal cross-sectional area increased by 0.024 cm2 per year, the nasopharyngeal cross-sectional area increased by 0.20 cm2 per year. No significant differences were found between boys and girls. Measurements of the posterior nasal and nasopharyngeal cross-sectional areas were unreliable, whenever the minimal cross-sectional area was less than 0.2 cm2. Furthermore, assessment of the nasopharynx may be difficult because of involuntary movements of the soft palate.